Getting ‘On Board” with Infection Control

Experts offer tips for improving compliance within your organization

Infection control has been a major concern for centuries, but received its biggest push in the 1970s when, among other milestones, the specialization of “infection control nurse” was popularized.

However, onboarding new employees and familiarizing each one remains a concern in modern-day hospital and healthcare facilities.

“It’s a tall order,” admitted Katherine Allen-Bridson, RN, BSN, MScPH, CIC, Lead-Protocol and Validation Team for CDC’s National Healthcare Safety Network, “especially if they’re coming in without having worked in infection prevention previously.”
The broadness of the field contributes to this challenge. “It usually takes me a good six months to feel comfortable in a role, but in infection prevention and control, it took me a good two years,” added Allen-Bridson.

Can a comprehensive onboarding program shorten that process? Allen-Bridson thinks so, but she says there are a few essential considerations.

Orientation Program: The more preparation and detail, the better.This program must address each and every activity the new hire will undertake, including an assessment of the individual’s own strengths and weaknesses. “After that, you personalize the program to be most effective for that individual,” said Allen-Bridson.

Mentoring: Ideally, the new hire will have a go-to resource—in the form of a co-worker—for any related questions. As time goes on, that mentor will remain more at arm’s length.

Standardized education: Several programs exist for the purpose of giving new professionals a solid background in infection control procedures. For instance, the Association for Professionals in Infection Control and Epidemiology has programs lasting several days that are aimed at new professionals in the field. “These programs are excellent for exposing people to the breadth of the information,” said Allen-Bridson.

Review of Existing Standards and Guidelines: Again, the availability of established, experienced professionals as resources is perhaps the most critical aspect of any onboarding process.

Creating awareness of the available certifications in infection prevention and control serves two purposes: new hires pursue the opportunities and become better versed in the subject, but they also observe the emphasis and importance your facility places on the topic. “There needs to be an understanding that the individual should be working towards these certifications,” Allen-Bridson reinforced.

Finally, once the new hire is fully versed in your program, it’s important to follow up. Within surveillance, the mentor can go over the decisions made, ensure that there’s agreement within the staff, and review the determinations that are ultimately created. This can be done via team meetings, case studies, and can lead to discussions of different viewpoints.

“It can take a while,” Allen-Bridson cautioned. “You need to develop a solid rapport so people know how they’re developing within the protocol.”

Dr. Arjun Srinivasan, MD (CAPT, USPHS) is the associate director of CDC’s Healthcare Associated Infection Prevention Program. He says he appreciates the complications and challenges within the onboarding process.

“It’s a tall order,” he said. “We ask our infection control colleagues to be experts in data analysis, interpretation and collection, but then we ask them to be experts in intervention and implementation as well.”

Of course, these functions operate independently of one another in most facilities, but your best infection preventionists are going to be experts in both areas.

Obstacles to Compliance

When asked how to overcome the red tape and obstacles that stand in the way of successful infection prevention programs, Dr. Srinivasan didn’t hesitate.

“Support,” he stated. “The support for the team has to come directly from the very highest levels of each facility’s leadership.

The C-Suite executives and the infection prevention/healthcare epidemiology team have to work in step with one another. “You need a mutual understanding of goals, the gaps preventing us from reaching those goals, and the thing that must happen to realize success,” said Dr. Srinivasan.

Unfortunately, Dr. Srinivasan’s experience dictates that this is the level where many problems begin. Many programs fail when the staff wants or needs to implement a measure, but hits a roadblock when they realize a lack of support from higher levels within the organization. “The implementation won’t happen, the interventions won’t be successful.

“And what are you left with? People saying ‘Hey, our infection rates haven’t gone down… what happened?’”

But perhaps the greatest obstacle to compliance is one that can’t be overcome—simple human behavior. When asking dozens or hundreds of people to do the same thing, it goes without saying that patterns will differ. So how does a program or facility adapt?

“It’s challenging, and it’s something we continue to struggle with on a daily basis,” admitted Dr. Srinivasan.

In his role, Dr. Srinivasan chooses to embrace these challenges as opportunities to create change. He summarizes this philosophy as “doing things in a different way, so we can make the right thing to do the easy thing to do.”

“This is not a case of people not wanting to do the right thing,” he emphasized. “Every healthcare provider wants to do right by their patients and provide the absolute best care.

“The question becomes how do you make that happen, when in a normal eight-hour shift a nurse might have to clean his or her hands over 100 times. That’s a hard thing to do. What can we do to help with that? How can we set up reminders and prompts, put materials in the right place?”

As a non-revenue generator, it’s difficult to monitor exactly what has been prevented at times. Therefore, the evidence of success isn’t as easy to observe as it might be in other areas. “Nobody does that on purpose,” clarified Allen-Bridsen. “It’s just human nature.”

Perhaps infection control is best summarized as having the same role as an umpire at a baseball game, or a smoke alarm in your home—if you don’t notice it at all, you’ll know it’s doing the job well.